The purpose of this study was to investigate the functional outcome of a group of patients following completely neglected tendo-achilles ruptures.

Between July 2001 and July 2002 we identified 6 patients who presented to the Foot and Ankle Service in Oxford with 7 chronic untreated complete ruptures of the tendo-achilles. There were 4 males and 2 females and the average age was 65 years (range 52 to 79). The average time since injury was 12.2 months (range 7 to 24). None of them had undergone any modality of treatment for this condition. From the history, a definite acute injury was confirmed in each patient. All patients had a palpable defect in the tendo-achilles between 4 and 8 cm from the insertion and the defects measured from 10 to 32 mm. In all case the Thompson test confirmed ongoing discontinuity and single leg heel raise was not possible on the affected side. Each patient was assessed using the scoring system of Leppilahti and concentric and eccentric power were assessed using the Kin-Com Dynamometer. The results indicate an average Leppilahti score of 65/100 with 1 excellent, 0 good, 3 fair and 2 poor. The isokinetic strength measurements demonstrated that plantar flexor power was on average 36% weaker than the normal side. These differences were most marked at the higher test speeds, which were on average 16% weaker than at the lowest test speed in the affected leg. Five out of 6 patients were pain free, with only one reporting mild pain. Objective testing demonstrated no differences in the range of movement between the injured and the normal side. All patients were satisfied with the outcome; however, most had some reservations, which related to ongoing weakness that prevented recreational activity.

Conclusion: At one year after injury the completely neglected tendo-achilles rupture in the older population is likely to be pain-free, to have full active ankle movement and to recover two-thirds of the power of plantar flexion compared to the unaffected limb. Ongoing weakness will prevent recreational activity but has minimal affect on activities of daily living including stair-climbing ability. We have established a benchmark of the natural history of this condition in the older patient against which the results of surgical treatment can be compared.

We performed a retrospective study of treatment of 50 patients above the age of 65 years with Tibial metaphyseal and diaphyseal fractures.

We studied the outcome by evaluation of all medical records and radiographs.

The mean duration of follow-up was 11 months. The average hospital stay was 19 days and the mean time in frame was 112 days. There were 2 non unions,3 significant malunions,2 refractures and 1 patient underwent an amputation.

Tibial fractures in the elderly are common and result in prolonged immobility and hospital admission. Fracture stabilization with an Ilizarov circular frame is an effective way of improving mobility with minimal additional morbidity, shorten hospitalisation time and achieve an excellent outcome.

Purpose: Anterior Cruciate Ligament (ACL) deficiency can result in symptomatic instability of the knee resulting in subsequent functional instability regardless of the patient’s age.

We reviewed a single surgeon database of 908 ACL reconstructions (ACLR’s) carried out in the last 20 years. 14 patients were identified who were 55 years or over at the time of ACLR (mean age: 60 years, range: 55–75 years). Patients were evaluated clinically and with clinical outcome scoring and KT-1000 arthrometry assessment. One patient had died but the other 13 patients were available to attend for follow-up at an average of 9.7 years post-ACLR. One patient had undergone total knee replacement. For the remainder: the most recent mean Lysholm score was 76 - improving from 35 pre-ACLR (p< 0.05); KT-1000 testing at 30 degrees flexion with 30lbs force demonstrated a side-to-side difference > 2mm in only one knee; only the same knee demonstrated a pivot shift. The most recent mean Tegner score was 3.10.

Conclusion: Anterior cruciate ligament reconstruction with autograft in the over-55 patient with minimal arthrosis is a safe procedure that returns stability to the knee and allows for return to a reasonable level of activity over the medium to long-term in the majority of cases.

Impaired vascularity of the skin in elderly ankle fracture patients causes the skin and wound complications. This is part of a RCT comparing ORIF and close contact casting (CCC) for isolated unstable ankle fractures in patients > 60 years. Assessments over 6-months

trans-cutaneous O2 saturation (TcP02) of medial and lateral ankle skin

The uninjured limb was the control.

Eighty-nine patients eligible; 59 participated (76% female). 30 randomised to ORIF; 29 to CCC. Each had one death and one withdrawal. Vascular data available on 55. Two patients had delays in wound healing (> 25% for > 6-weeks). Two further developed wound infections. No skin breakdowns in CCC group. There was a reduced TcP02 on day-3 in the injured limb. The TcP02 rose at 6-weeks compared to day-3 (medial 58mmHg; lateral 53mmHg, p=0.002) in the injured leg. At 6-months the TcP02 measurements were not different to uninjured leg. A critical TcP02 (< 20mmHg) found in 4, correlated with skin problems (p=0.003). Two of these had the only major delays in wound healing and one of the two wound infections.

94% of participants had normal ABPI’s (> 1.0). There was no difference between patients with or without an impaired ABPI (< 0.7 mm Hg) and wound problems (p=0.20).

There was no difference in patent perforators between the injured and uninjured (p=0.39).

Occult vascular insufficiency is present but at low incidence. ABPI and Duplex-US are insensitive for predicting infection or delayed healing. The ankle fracture injury does not disrupt the local perforators. TcPO2 is sensitive and specific for predicting skin problems. Impairment of skin oxygenation is transient. Current TcPO2 technology however is impractical as a clinical tool.

Between 2003 and 2007, 99 knees in 77 patients underwent opening wedge high tibial osteotomy. We evaluated the effect of initial stable fixation combined with an artificial bone substitute on the mid- to long-term outcome after medial opening-wedge high tibial osteotomy (HTO) for medial compartmental osteoarthritis or spontaneous osteonecrosis of the knee in 78 knees in 64 patients available for review at a minimum of five years (mean age 68 years; 49 to 82). The mean follow-up was 6.5 years (5 to 10). The mean Knee Society knee score and function score improved from 49.6 (sd 11.4, 26 to 72) and 56.6 (sd 15.6, 5 to 100) before surgery to 88.1 (sd 12.5, 14 to 100) and 89.4 (sd 15.6, 5 to 100) at final follow-up (p <  0.001) respectively. There were no significant differences between patients aged ≥ 70 and < 70 years. The mean standing femorotibial angle was corrected significantly from 181.7° (sd 2.7°, 175° to 185°) pre-operatively to 169.7° (sd 2.4°, 164° to 175°) at one year’s follow-up (p < 0.001) and 169.6° (sd 3.0°, 157° to 179°) at the final follow-up (p = 0.69 vs one year).

Opening-wedge HTO using a stable plate fixation system combined with a bone substitute is a reliable procedure that provides excellent results. Although this treatment might seem challenging for older patients, our results strongly suggest that the results are equally good.

Cite this article: Bone Joint J 2014;96-B:339–44.

The April 2024 Oncology Roundup. 360. looks at: Midterm outcomes of total hip arthroplasty after internal hemipelvectomy and iliofemoral arthrodesis; Intraosseous conventional central chondrosarcoma does not metastasize irrespective of grade in pelvis, scapula, and in long bone locations; Oncological and functional outcomes after resection of malignant tumours of the scapula; Reconstruction following oncological iliosacral resection – a comparison of techniques; Does primary tumour resection improve survival for patients with sarcomas of pelvic bones, sacrum, and coccyx who have metastasis at diagnosis?; Older patients with Ewing’s sarcoma: an analysis of the National Cancer Database; Diagnostic challenges in low-grade central osteosarcoma; Effect of radiotherapy on local recurrence, distant metastasis, and overall survival in 1,200 limb soft-tissue sarcoma patients: a retrospective analysis using inverse probability of treatment weighting-adjusted models

Aims. The aim of this study was to capture 12-month outcomes from a representative multicentre cohort of patients undergoing total ankle arthroplasty (TAA), describe the pattern of patient-reported outcome measures (PROMs) at 12 months, and identify predictors of these outcome measures. Methods. Patients listed for a primary TAA at 19 NHS hospitals between February 2016 and October 2017 were eligible. PROMs data were collected preoperatively and at six and 12 months including: Manchester-Oxford Foot and Ankle Questionnaire (MOXFQ (foot and ankle)) and the EuroQol five-dimension five-level questionnaire (EQ-5D-5L). Radiological pre- and postoperative data included Kellgren-Lawrence score and implant position measurement. This was supplemented by data from the National Joint Registry through record linkage to determine: American Society of Anesthesiologists (ASA) grade at index procedure; indication for surgery, index ankle previous fracture; tibial hind foot alignment; additional surgery at the time of TAA; and implant type. Multivariate regression models assessed outcomes, and the relationship between MOXFQ and EQ-5D-5L outcomes, with patient characteristics. Results. Data from 238 patients were analyzed. There were significant improvements in MOXFQ and EQ-5D-5L among people who underwent TAA at six- and 12-month assessments compared with preoperative scores (p < 0.001). Most improvement occurred between preoperative and six months, with little further improvement at 12 months. A greater improvement in MOXFQ outcome postoperatively was associated with older age and more advanced radiological signs of ankle osteoarthritis at baseline. Conclusion. TAA significantly benefits patients with end-stage ankle disease. The lack of substantial further overall change between six and 12 months suggests that capturing PROMs at six months is sufficient to assess the success of the procedure. Older patients and those with advanced radiological disease had the greater gains. These outcome predictors can be used to counsel younger patients and those with earlier ankle disease on the expectations of TAA. Cite this article: Bone Joint J 2023;105-B(8):895–904

Aims. The aim of this study was to review the provision of total elbow arthroplasties (TEAs) in England, including the incidence, the characteristics of the patients and the service providers, the types of implant, and the outcomes. Methods. We analyzed the primary TEAs recorded in the National Joint Registry (NJR) between April 2012 and December 2022, with mortality data from the Civil Registration of Deaths dataset. Linkage with Hospital Episode Statistics-Admitted Patient Care (HES-APC) data provided further information not collected by the NJR. The incidences were calculated using estimations of the populations from the Office for National Statistics. The annual number of TEAs performed by surgeons and hospitals was analyzed on a national and regional basis. Results. A total of 3,891 primary TEAs were included. The annual incidence of TEA was between 0.72 and 0.82 per 100,000 persons before 2020 and declined to 0.4 due to a decrease in elective TEAs during the COVID-19 pandemic, with a slight recovery in 2022. Older patients, those of white ethnicity and females, were more likely to undergo TEA. Those who underwent elective TEA had a median wait of between 89 (IQR 41 to 221) and 122 days (IQR 74 to 189) in the years before 2021, and this increased to 183 days (IQR 66 to 350) in 2021. The number of TEAs performed by surgeons per annum remained unchanged, with a median of two (IQR 1 to 3). The median annual number of TEAs per region was three to six times higher than the median annual case load of the highest volume hospital in a region. Patients in the lowest socioeconomic group had a higher rate of serious adverse events and mortality (11%) when undergoing TEA for acute trauma. Conclusion. In England, TEA is more common in older age groups, those of white ethnicity, and females. The COVID-19 pandemic affected the incidence of elective TEA and waiting times, and the provision of TEA has not yet recovered. The Getting it Right First Time recommendation of centralizing services to one centre per region could result in up to a six-fold increase in the number of TEAs being performed in some centres. Cite this article: Bone Joint J 2024;106-B(11):1312–1320

Abstract. Introduction. The NHS long term plan endorses ‘personalised’, ‘digitally enabled’, ‘out of hospital’ care. Multiagency guidance (CPOC(2021)/NICE(2021)/GIRFT(2021)/NHSX(2021)) advocates an integrated ‘pathway’ approach to information sharing, shared-decision making and patient support. Digital solutions are the vehicle to deliver these agendas. Methods. In 2018 we developed a digital joint pathway (DJP) spanning the surgical care pathway (prehabilitation to rehabilitation) using the GoWellHealth platform. Patients listed for joint replacement are offered the DJP as routine care. Activity and engagement are monitored using the DJP data library. We sought to evidence our DJP by assessing patient engagement, experience and outcomes (OKS/EQ5D/Readmission). Results. Engagement. Consecutive cohort of the first 1195 patients registered. Activation rates were >85% and >70% viewed content within the DJP (median=15 access/pt; mean=83 minutes on DJP/pt). Engagement was similar irrespective of age and gender (p=NS). Older patients preferred to access via a computer. Experience. Qualitative interviews (n=14) demonstrated patients felt the DJP impacted positively on their health behaviours and contributed to their recovery. They spoke positively about the use of technology and the accessibility of the DJP. Outcomes. Comparison of patients on the DJP versus those not on the DJP using adjusted regression models demonstrated improved EQ5D=0.070 (95%CI=0.004-0.135,p=0.04), OKS=5.0 (95%CI=2.2-7.8,p<0.001) and readmission rates (3.6% versus 5.6%,p<0.01) for DJP patients. Conclusions. A DJP model for information delivery and patient support, across the entirety of the surgical pathway, is feasible and demonstrates high levels of patient engagement, experience and improved patient outcomes

Aims. Wear of the polyethylene (PE) tibial insert of total knee arthroplasty (TKA) increases the risk of revision surgery with a significant cost burden on the healthcare system. This study quantifies wear performance of tibial inserts in a large and diverse series of retrieved TKAs to evaluate the effect of factors related to the patient, knee design, and bearing material on tibial insert wear performance. Methods. An institutional review board-approved retrieval archive was surveyed for modular PE tibial inserts over a range of in vivo duration (mean 58 months (0 to 290)). Five knee designs, totalling 1,585 devices, were studied. Insert wear was estimated from measured thickness change using a previously published method. Linear regression statistical analyses were used to test association of 12 patient and implant design variables with calculated wear rate. Results. Five patient-specific variables and seven implant-specific variables were evaluated for significant association with lower insert wear rate. Six were significant when controlling for other factors: greater patient age, female sex, shorter duration in vivo, polished tray, highly cross-linked PE (HXLPE), and constrained knee design. Conclusion. This study confirmed that knee wear rate increased with duration in vivo. Older patients and females had significantly lower wear rates. Polished modular tibial tray surfaces, HXLPE, and constrained TKA designs were device design factors associated with significantly reduced wear rate. Cite this article: Bone Joint J 2021;103-B(11):1695–1701

Aims. Postoperative complication rates remain relatively high after adult spinal deformity (ASD) surgery. The extent to which modifiable patient-related factors influence complication rates in patients with ASD has not been effectively evaluated. The aim of this retrospective cohort study was to evaluate the association between modifiable patient-related factors and complications after corrective surgery for ASD. Methods. ASD patients with two-year data were included. Complications were categorized as follows: any complication, major, medical, surgical, major mechanical, major radiological, and reoperation. Modifiable risk factors included smoking, obesity, osteoporosis, alcohol use, depression, psychiatric diagnosis, and hypertension. Patients were stratified by the degree of baseline deformity (low degree of deformity (LowDef)/high degree of deformity (HighDef): below or above 20°) and age (Older/Younger: above or below 65 years). Complication rates were compared for modifiable risk factors in each age/deformity group, using multivariable logistic regression analysis to adjust for confounders. Results. A total of 480 ASD patients met the inclusion criteria. By two years, complication rates were 72% ≥ one complication, 28% major, 21% medical, 27% surgical, 11% major radiological, 8% major mechanical, and 22% required reoperation. Younger LowDef patients with osteoporosis were more likely to suffer either a major mechanical (odds ratio (OR) 5.9 (95% confidence interval (CI) 1.1 to 36.9); p = 0.048) or radiological complication (OR 7.0 (95% CI 1.9 to 25.9); p = 0.003). Younger HighDef patients were much more likely to develop complications if obese, especially major mechanical complications (OR 2.8 (95% CI 1.1 to 8.6); p = 0.044). Older HighDef patients developed more complications when diagnosed with depression, including major radiological complications (OR 3.5 (95% CI 1.1 to 10.6); p = 0.033). Overall, a diagnosis of depression proved to be a risk factor for the development of major radiological complications (OR 2.4 (95% CI 1.3 to 4.5); p = 0.005). Conclusion. Certain modifiable patient-related factors, especially osteoporosis, obesity, and mental health status, are associated with an increased risk of complications after surgery for spinal deformity. Surgeons should look for these conditions when assessing a patient for surgery, and optimize them to the fullest extent possible before proceeding to surgical correction so as to minimize the prospect of postoperative morbidity. Cite this article: Bone Joint J 2022;104-B(11):1249–1255

The Step Holter is a software and mobile application that can be used to easily study gait analysis. The application can be downloaded for free on the App Store and Google Play Store for iOS and Android devices. The software can detect with an easy calibration the three planes to detect the movement of the gait. Before proceeding with the calibration, the smartphone can be placed and fixed with a band or stowed into a long sock with its top edge at the height of the joint line, in the medial side of the tibia. The calibration consists in bending the knee about 20 to 30 degrees and then making a rotation movement, leaving the heel fixed to the ground as a rotation fulcrum. After calibration, the program records data related to lateral flexion, rotation, and bending of the leg. This data can be viewed directly from the smartphone screen or transmitted via a web link to the Step Holter web page . www.stepholter.com. by scanning a personal QR code. The web page allows the users to monitor the test during its execution or view data for tests done previously. By pressing the play button, it is possible to see a simulation of the patient's leg and its movement. With the analyze button, the program is capable of calculating the swing and stance phase of every single step, providing a plot with time and percentages. Finally, with the Get Excel button, test data can be conveniently exported for more in-depth research. The advantage of this application is not only to reduce the costs of a machine for the study of gait analysis but also being able to perform tests quickly, without expensive hardware or software and be used in specific spaces, without specialized personnel. Furthermore, the application can collect important data concerning rotation that cannot be highlighted with the classic gait analysis. The versatility of a smartphone allows tests to be carried out not only during walking but also by climbing or descending stairs or sitting down or getting up from a chair. This software offers the possibility to easily study any kind of patients; Older patients, reluctant to leave their homes for a gait analysis can be tested at home or during an office control visit. Step Holter could be one small step for patients, one giant leap for gait study simplicity. For any figures or tables, please contact authors directly

Purpose. Due to the aging population, an increasing proportion of elderly patients with soft tissue sarcoma are presenting to cancer centers. This population appears to have a worse prognosis but the reasons for this has not been studied in depth. The purpose of this study is to examine the effect of age on the outcome of patients with extremity and trunk soft tissue sarcoma. Method. This is a multicenter study including 2071 patients with median age at operation of 57 years (1st quartile–3rd quartile: 42–70). The endpoints considered were local recurrence and metastasis with death as a competing event. Cox proportional hazards models were used to estimate hazard ratios across the age ranges with and without adjustment for known confounding factors. Results. Older patients presented with tumors that were larger and of higher grade. The proportion of positive margins increased progressively as patients aged, but radiation therapy was relatively underused in patients over 60 years old. Age was strongly associated with both local recurrence and metastasis. The 5-year cumulative incidences of local recurrence were 7.6% (4.2%–12.2%) for patients 30 years or younger and 13.8% (9.8%–18.5%) for patients 75 years and older; corresponding 5-year cumulative incidences of metastasis were 21.5% (15.7%–28%) and 32.5% (27%–38.2%) for the same groups. Age showed a non linear effect with a dramatic increase in the risk of local recurrence and metastasis after 60 years old. The increased risk of metastasis for older patients was explained by disparities in tumor characteristics at presentation, and additionally for local recurrence, by disparities in treatment. Conclusion. Age is associated with worse outcomes after resection of soft tissue sarcoma. Older patients have worse outcomes because they tend to present with tumors having more adverse prognostic features and they are also treated less aggressively. A significant effect of age that is not explained by known confounders remains

Introduction. Meaningful clinical improvement as demonstrated through patient-reported outcome measures (PROMs) are increasingly used to evaluate success of total hip arthroplasty (THA) procedures. This patient perspective can provide a full picture when used with clinical data to best evaluate surgical outcomes. Methods. All primary THA procedures reported to the American Joint Replacement Registry from 2012–2018 with linked pre-operative and 1-year post-operative functional or anatomical PROMs were included. The achievement of minimal clinically-important difference (MCID) was calculated using the distribution method. Logistic regression models with covariate adjustment for patient demographics, American Society of Anesthesiologists (ASA) score, and body mass index (BMI) were constructed to identify associations with PROMs. Results were analyzed based on hospital size (small, medium and large) and teaching type (non-teaching, minor and major) based on the American Hospital Association Survey (2015). Results. There were 3,952 THA with pre-operative and 1-year post-operative PROMs. The five types of PROMs collected include: HOOS (n=731), HOOS Jr. (n=295), PROMIS-10 (n=1,074), SF-36 (n=976), VR-12 (1,262). The average age was 66.3±10.5 years, and the majority were female (54.7%). 53.1% of THA patients achieved MCID. Age and gender were statistically significant, while ASA score and BMI classification were not. As age increased by 1 year, the odds of achieving MCID increased 0.8% (OR 0.992, 95%CI 0.984, 0.999) and a minor versus major teaching hospital was 20.8% less likely to achieve MCID (p<0.04). While small hospital sizes had significantly fewer linked PROMs (6.5% of all linked PROMs), only 44.5% achieved MCID compared to medium (52.3%) and large (54.5%) hospitals (p<0.02). Conclusion. Older patient age, major teaching hospitals, and large hospitals achieved higher levels of MCID after THA. Identifying patients that are less likely to achieve MCID can aid physicians by determining patients at risk for poor outcomes, then guiding patient expectations and providing patient-centered care. For any tables or figures, please contact the authors directly

Introduction. There is insufficient data on the trends of anticoagulation after total knee arthroplasty (TKA) in the USA, and the efficacy and safety of rivaroxaban, beyond randomized clinical trials and small cohort studies. Patients and Methods. Using the Truven Health MarketScan database, we retrospectively evaluated new anticoagulation prescriptions after elective TKA from 2010 to 2015. The frequency of deep vein thrombosis (DVT), pulmonary embolism (PE), and adverse events, within 90 days, were then evaluated in 24,856 new users of warfarin and 21,398 new users of rivaroxaban in commercially insured patients (COM), and 15,483 new users of warfarin and 8,997 new users of rivaroxaban in Medicare supplement patients (MED). Data was analyzed by odds ratios using logistic regression models with stabilized inverse probability treatment weighting. Results. Warfarin use decreased from approximately 50% to 17% in COM patients and 60% to 25% in MED patients. Rivaroxaban use increased from 0 to 35% in COM patients and from 0 to 39% in MED patients. Older patients, females, a history of DVT, renal impairment, use of antiplatelet agents or surgery performed as an outpatient had lower odds of getting rivaroxaban. Patients in Western region and having surgery in 2015 had higher odds of getting rivaroxaban. COM patients with capitated insurance plans and a history of PE had lower odds of rivaroxaban initiation. MED patients with atrial fibrillation, cardiovascular disease or hyperlipidemia had lower odds of rivaroxaban initiation. Warfarin users had significantly higher odds ratio of DVT (OR 2.06 in COM patients and OR 2.21 in MED patients) and PE (OR 2.03 in COM patients and OR 2.16 in MED patients) than rivaroxaban users. There were no statistically significant differences in the bleeding risk between the two agents, but warfarin users had a significantly higher odds ratio of periprosthetic infection in both COM (1.57) and MED (1.79) patients. Conclusions. There has been an increase in prophylaxis with rivaroxaban, and a decrease in both warfarin and LMWH use after elective TKA over four years. Rivaroxaban had lower odds ratio of both DVT and PE than warfarin, and bleeding risks were similar. For figures, tables, or references, please contact authors directly

Background. Total Knee Arthroplasty (TKA) provides patients with significant improvements in quality of life. Subjective patient reported outcome measures (PROMs) are traditionally used to measure preoperative functional status and postoperative outcomes. However, there are limitations to PROMs. In particular, they provide virtually no functional information in the first 3 weeks after surgery, which could be used to guide the patient's recovery. Newly available wearable electronic sensors make it possible to: 1) measure important functional outcomes following TKA; 2) guide the patient's physical therapy (PT); and 3) provide real-time functional and clinical information to the provider. Compliance with PT after TKA is a challenge. Patients cite time, transportation, and cost as deterrents to PT appointments. However, an intensive PT program is essential in TKA. Surface sensor devices may be able to increase PT compliance by guiding patients through exercises at home. Additionally, these devices can transmit PT progress in real-time to the providers, allowing them to monitor and assist the patient's recovery. Our study investigates the feasibility of using a surface sensor device (TracPatch™) on patients following TKA. We sought to answer the following questions: 1) Will patients tolerate the device; 2) Will patients comply with device instructions; 3) Will patients be able to use the smart phone application; 4) Will the device collect, transmit, and store data as it was designed? We believe these fundamental questions must be answered as we enter the era of personal sensor-measured functional outcomes. Methods. 20 patients undergoing primary, unilateral TKA were enrolled in this IRB approved study. At the pre-surgical visit, patients were given instructions for the device and smart phone application. Each patient used the device in the week prior to surgery, and data was collected. The device was again applied in the operating room. For 3 weeks post-operatively, the device collected functional data, along with WOMAC, OKS, KSS, PROMIS, and VAS pain scores. A satisfaction survey was collected on the device. Results. The study results emphasize the importance of clear device instructions. Using the sensor and phone application prior to surgery was very helpful. The device was surprisingly well tolerated. Older patients were able to use the device without significant difficulty. Virtually all patients found the device helpful and, often fun. Physical therapists felt that the devices helped personalize the therapy program. The functional information from the device was much more helpful in guiding care in the first 3 weeks following surgery than PROM scores. Conclusion. It is anticipated that sensor devices of the kind tested in this study will have a major impact on the care of TKA patients. The purpose of this study was not to measure that impact. Our goal was to examine the factors that optimize the use of these devices. It is critical that clear device instructions be given to patients. Office procedures must be established to monitor use of the devices. If protocols are established for their use, surface sensors have the potential to provide invaluable information to TKA patients and caregivers

The fingers and thumb are the second most common site for dislocation of joints following injury (3.9/10,000/year). Unlike fractures, the pattern and patient reported outcomes following dislocations of the hand have not previously been reported. All patients presenting with a dislocation or subluxation of the fingers or thumb were included in this cohort study (November 2008 and October 2009). Patient demographic and injury data were obtained and dislocation pattern confirmed on radiographs. Patient reported outcomes were obtained using the Michigan Hand Outcome Questionnaire (MHQ). There were 202 dislocations/subluxations recorded. MHQ scores were obtained at 3–5 years for 74percnt; patients. The average age at injury was 40 years, 76percnt; (146) patients were male and 11percnt; (23) injuries were open. 50percnt; (101) of the dislocations were dorsal, 28percnt; (57) were associated with fractures and 4percnt; (9) were recurrent. There were significant associations between: 1, Direction of dislocation and finger involved (p=0.03); 2, Joint and mechanism of dislocation (p=0.001); 3, Mechanism and direction of dislocation (p=0.008). Older patients had significantly worse outcomes (p<0.001). This is the first study to assess the epidemiology and patient reported outcomes following dislocation of the fingers and thumb allowing us to better understand these injuries

Objectives. To assess the effectiveness of a modified tibial tubercle osteotomy as a treatment for arthroscopically diagnosed chondromalacia patellae. Methods. A total of 47 consecutive patients (51 knees) with arthroscopically proven chondromalacia, who had failed conservative management, underwent a modified Fulkerson tibial tubercle osteotomy. The mean age was 34.4 years (19.6 to 52.2). Pre-operatively, none of the patients exhibited signs of patellar maltracking or instability in association with their anterior knee pain. The minimum follow-up for the study was five years (mean 72.6 months (62 to 118)), with only one patient lost to follow-up. Results. A total of 50 knees were reviewed. At final follow-up, the Kujala knee score improved from 39.2 (12 to 63) pre-operatively to 57.7 (16 to 89) post-operatively (p < 0.001). The visual analogue pain score improved from 7.8 (4 to 10) pre-operatively to 5.0 (0 to 10) post-operatively. Overall patient satisfaction with good or excellent results was 72%. Patients with the lowest pre-operative Kujala score benefitted the most. Older patients benefited less than younger ones. The outcome was independent of the grade of chondromalacia. Six patients required screw removal. There were no major complications. Conclusions. We conclude that this modification of the Fulkerson procedure is a safe and useful operation to treat anterior knee pain in well aligned patellofemoral joints due to chondromalacia patellae in adults, when conservative measures have failed

Aims

The aim of this study was to evaluate the association between chondral injury and interval from anterior cruciate ligament (ACL) tear to surgical reconstruction (ACLr).

Aims. Chronic conditions of the wrist may be difficult to manage because pain and psychiatric conditions are correlated with abnormal function of the hand. Additionally, intra-articular inflammatory cytokines may cause pain. We aimed to validate the measurement of inflammatory cytokines in these conditions and identify features associated with symptoms. Patients and Methods. The study included 38 patients (18 men, 20 women, mean age 43 years) with a chronic condition of the wrist who underwent arthroscopy. Before surgery, the Self-Rating Depression Scale (SDS), Hand20 questionnaire and a visual analogue scale (VAS) for pain were used. Cytokine and chemokine levels in the synovial fluid of the wrist were measured using enzyme-linked immunosorbent assays and correlations between the levels with pain were analysed. Gene expression profiles of the synovial membranes were assessed using quantitative polymerase chain reaction. Results. Older patients had high pre-operative Hand20 scores. One-year post-operative Hand20 and VAS scores and pre-operative VAS scores correlated with SDS scores. Post-operative VAS scores negatively correlated with the expression of nerve growth factor and SDS scores positively correlated with the expression of tumour necrosis factor-alpha and negatively correlated with the expression of tumour necrosis factor-converting enzyme. Conclusion. There was a positive correlation between depression and chronic conditions of the wrist. Levels of some cytokines correlate with pain and depression. Additionally, cytokines may be important in the assessment and treatment of chronic conditions of the wrist and depression. Cite this article: Bone Joint J 2016;98-B:961–8